<?php
/* @var $this ReviewSystemsController */
/* @var $model ReviewSystems */
/* @var $form CActiveForm */
?>

<div class="form">

<?php $form=$this->beginWidget('CActiveForm', array(
	'id'=>'review-systems-form',
	'enableAjaxValidation'=>false,
)); ?>

	<p class="note">Fields with <span class="required">*</span> are required.</p>

	<?php echo $form->errorSummary($model); ?>

	<div class="column">
		<?php echo $form->labelEx($model,'Fever, Weight Loss/Gain'); ?>
		<?php echo $form->dropDownList($model,'fever_weight_loss_or_gain', array('-' => '-','Yes'=>'Yes','No'=>'No')); ?>
		<?php echo $form->error($model,'fever_weight_loss_or_gain'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'Integumentary (Skin)'); ?>
		<?php echo $form->dropDownList($model,'integumentary', array('-' => '-','Yes'=>'Yes','No'=>'No')); ?>
		<?php echo $form->error($model,'integumentary'); ?>
	</div>

	<div class="column">
		<?php echo $form->labelEx($model,'neurological'); ?>
		<?php echo $form->dropDownList($model,'neurological', array('-' => '-','Yes'=>'Yes','No'=>'No')); ?>
		<?php echo $form->error($model,'neurological'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'headaches'); ?>
		<?php echo $form->dropDownList($model,'headaches', array('-' => '-','Yes'=>'Yes','No'=>'No')); ?>
		<?php echo $form->error($model,'headaches'); ?>
	</div>

	<div class="column">
		<?php echo $form->labelEx($model,'migraines'); ?>
		<?php echo $form->dropDownList($model,'migrains', array('-' => '-','Yes'=>'Yes','No'=>'No')); ?>
		<?php echo $form->error($model,'migrains'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'seizures'); ?>
		<?php echo $form->dropDownList($model,'seizures', array('-' => '-','Yes'=>'Yes','No'=>'No')); ?>
		<?php echo $form->error($model,'seizures'); ?>
	</div>

	<div class="column">
		<?php echo $form->labelEx($model,'eyes'); ?>
		<?php echo $form->dropDownList($model,'eyes', array('-' => '-','Yes'=>'Yes','No'=>'No')); ?>
		<?php echo $form->error($model,'eyes'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'loss_of_vision'); ?>
		<?php echo $form->dropDownList($model,'loss_of_vision', array('-' => '-','Yes'=>'Yes','No'=>'No')); ?>
		<?php echo $form->error($model,'loss_of_vision'); ?>
	</div>

	<div class="column">
		<?php echo $form->labelEx($model,'distorted_vision'); ?>
		<?php echo $form->dropDownList($model,'distorted_vision', array('-' => '-','Yes'=>'Yes','No'=>'No')); ?>
		<?php echo $form->error($model,'distorted_vision'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'Loss of Side Vision'); ?>
		<?php echo $form->dropDownList($model,'loss_side_vision', array('-' => '-','Yes'=>'Yes','No'=>'No')); ?>
		<?php echo $form->error($model,'loss_side_vision'); ?>
	</div>

	<div class="column">
		<?php echo $form->labelEx($model,'double_vision'); ?>
		<?php echo $form->dropDownList($model,'double_vision', array('-' => '-','Yes'=>'Yes','No'=>'No')); ?>
		<?php echo $form->error($model,'double_vision'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'dryness'); ?>
		<?php echo $form->dropDownList($model,'dryness', array('-' => '-','Yes'=>'Yes','No'=>'No')); ?>
		<?php echo $form->error($model,'dryness'); ?>
	</div>

	<div class="column">
		<?php echo $form->labelEx($model,'Mucous Discharge'); ?>
		<?php echo $form->dropDownList($model,'mucousdischarge', array('-' => '-','Yes'=>'Yes','No'=>'No')); ?>
		<?php echo $form->error($model,'mucousdischarge'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'redness'); ?>
		<?php echo $form->dropDownList($model,'redness', array('-' => '-','Yes'=>'Yes','No'=>'No')); ?>
		<?php echo $form->error($model,'redness'); ?>
	</div>

	<div class="column">
		<?php echo $form->labelEx($model,'Sandy or Gritty Feeling'); ?>
		<?php echo $form->dropDownList($model,'sandy_gritty_feeling', array('-' => '-','Yes'=>'Yes','No'=>'No')); ?>
		<?php echo $form->error($model,'sandy_gritty_feeling'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'itching'); ?>
		<?php echo $form->dropDownList($model,'itching', array('-' => '-','Yes'=>'Yes','No'=>'No')); ?>
		<?php echo $form->error($model,'itching'); ?>
	</div>

	<div class="column">
		<?php echo $form->labelEx($model,'burning'); ?>
		<?php echo $form->dropDownList($model,'burning', array('-' => '-','Yes'=>'Yes','No'=>'No')); ?>
		<?php echo $form->error($model,'burning'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'foreign_body_sensation'); ?>
		<?php echo $form->dropDownList($model,'foreign_body_sensation', array('-' => '-','Yes'=>'Yes','No'=>'No')); ?>
		<?php echo $form->error($model,'foreign_body_sensation'); ?>
	</div>

	<div class="column">
		<?php echo $form->labelEx($model,'Excess Tearing / Watering'); ?>
		<?php echo $form->dropDownList($model,'excess_tearing', array('-' => '-','Yes'=>'Yes','No'=>'No')); ?>
		<?php echo $form->error($model,'excess_tearing'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'Glare/ Light Sensitivity'); ?>
		<?php echo $form->dropDownList($model,'glare', array('-' => '-','Yes'=>'Yes','No'=>'No')); ?>
		<?php echo $form->error($model,'glare'); ?>
	</div>

	<div class="column">
		<?php echo $form->labelEx($model,'Eye Pain or Soreness'); ?>
		<?php echo $form->dropDownList($model,'soreness', array('-' => '-','Yes'=>'Yes','No'=>'No')); ?>
		<?php echo $form->error($model,'soreness'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'Chronic Infection of Eye or Lid'); ?>
		<?php echo $form->dropDownList($model,'chronicinfection_on_eyes', array('-' => '-','Yes'=>'Yes','No'=>'No')); ?>
		<?php echo $form->error($model,'chronicinfection_on_eyes'); ?>
	</div>

	<div class="column">
		<?php echo $form->labelEx($model,'Styes or Chalazion'); ?>
		<?php echo $form->dropDownList($model,'sties', array('-' => '-','Yes'=>'Yes','No'=>'No')); ?>
		<?php echo $form->error($model,'sties'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'Flashes'); ?>
		<?php echo $form->dropDownList($model,'Flashes', array('-' => '-','Yes'=>'Yes','No'=>'No')); ?>
		<?php echo $form->error($model,'Flashes'); ?>
	</div>

	<div class="column">
		<?php echo $form->labelEx($model,'Tired Eyes'); ?>
		<?php echo $form->dropDownList($model,'tiredeyes', array('-' => '-','Yes'=>'Yes','No'=>'No')); ?>
		<?php echo $form->error($model,'tiredeyes'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'Endocrine'); ?>
		<?php echo $form->dropDownList($model,'endocrine', array('-' => '-','Yes'=>'Yes','No'=>'No')); ?>
		<?php echo $form->error($model,'endocrine'); ?>
	</div>

	<div class="column">
		<?php echo $form->labelEx($model,'Thyroid/ Other Gland'); ?>
		<?php echo $form->dropDownList($model,'thyroid_othe_rgland', array('-' => '-','Yes'=>'Yes','No'=>'No')); ?>
		<?php echo $form->error($model,'thyroid_othe_rgland'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'chief_complaints'); ?>
		<?php echo $form->textField($model,'chief_complains',array('size'=>60,'maxlength'=>300)); ?>
		<?php echo $form->error($model,'chief_complains'); ?>
	</div>

	<div class="column">
		<?php echo $form->labelEx($model,'medications_taken'); ?>
		<?php echo $form->textField($model,'medication_taken',array('size'=>60,'maxlength'=>300)); ?>
		<?php echo $form->error($model,'medication_taken'); ?>
	</div>
<br>
<br>

	<div class="column">
		<?php echo $form->labelEx($model,'Patient Name'); ?>
		<?php echo $form->dropDownList($model,'personalinfo_id', CHtml::listData(

		PersonalInformation::model() ->findAll(), 'id','fname', 'lname'), array('prompt' => 'Select Patient')); ?>

		<?php echo $form->error($model,'personalinfo_id'); ?>
	</div>

	<div class="row buttons">
		<?php echo CHtml::submitButton($model->isNewRecord ? 'Create' : 'Save'); ?>
	</div>

<?php $this->endWidget(); ?>

</div><!-- form -->